（仲景）
治伤寒中风少阳证，往来寒热，胸胁痞满，默默不欲食，心烦喜呕；或腹中痛，或胁下
痛，或渴，或咳，或利，或悸，小便不利，口苦耳聋，脉弦；或汗后余热不解；及春月时嗽，
疟发寒热，妇人伤寒热入血室（寒为阴，热为阳；里为阴，表为阳；邪客于半表半里，阴出
与阳争，阴胜则寒；阳入与阴争，阳胜则热；阳不足则先寒，阴不足则先热。又曰∶太阳行
身之后，属膀胱寒水，为表；阳明行身之前，属胃燥金，为表之里；邪在于中，近后膀胱水
则寒，近前阳明燥则热也。寒热有定时者为疟，无定时者为往来寒热，以热在表而浅，邪恶
正故畏寒，寒已复热，此邪未并于表里，故寒热微而无定时也。半表半里，属足少阳胆脉，
行于两胁，手少阳三焦之脉络心包，风邪干之，心气不得宣畅，故烦满，或攻胸胁，故又胸
胁痛也。邪在表则呻吟不安，在里则烦而闷乱，邪自表而方传里，故默默静也。经曰∶阳入
之阴则静，邪在表则能食，入里则不能食，今在表里之间，故但不欲食，未至于不能食也。
邪在表则不烦不呕，在里则烦呕，表方传里，故心烦喜呕也。里虚协热，故或渴或利，或腹
中痛；里有停饮，故悸而小便不利；少阳胆脉络于耳，故耳聋；胆气上溢，故口苦；胆与肝
皆属木，故脉弦；春月时嗽，少阳当令之时也。血室，冲脉也，男女皆有之，妇人伤寒七八
日，邪当传里，值经水适来，则邪不入腑，乘虚而入血室；或经水适断，表邪乘虚亦入血室，
热与血搏结而不行，致有寒热如疟，暮则谵语如见鬼状，在男子则下血谵语，皆为热入血室
。妇人伤寒与男子无异，惟热入血室、妊娠伤寒为不同也。小柴胡在经主气，在脏主血，故
更能入血室。经曰∶伤寒中风，有柴胡证，但见一证便是，不必悉具。又曰∶伤寒五六日，
发热而呕，医以他药下之，柴胡证仍在者，复与柴胡汤，必蒸蒸而振，发热汗出而愈。或湿
热在半表半里而发黄者，仍与小柴胡汤和其表里，虽杂证不能外也；亦治伤寒五六日，头汗
出，微恶寒，手足冷，心下满，不欲食，大便硬，细者，为阳微结仲景曰∶汗出为阳微，假
令纯阴结，不得复有外证，脉虽沉紧，不得为少阴病，所以然者，阴不得有汗，今头有汗，
故知非少阴也。按∶三阴脉皆至颈、胸中而还，不上循头。程郊倩曰∶热虽结而不甚也，以
有微恶寒之半表在，至于脉沉，虽似里阴，则又有头汗出之证以别之，凡脉细、脉沉、脉紧
，皆阳热郁结之证，无关少阴也，可见阳气一结，不但阳证似阴，阳脉亦似阴矣）。
柴胡（八两） 半夏（半升） 人参 甘草 黄芩 生姜（三两） 大枣（十二枚）。
呕逆加生姜、陈皮（生姜散逆，陈皮顺气）；烦而不呕去半夏、人参，加栝蒌（以荡郁热）；
渴者去半夏，加花粉（生津）；若不渴，外有微热，去人参，加桂枝覆取微汗（解肌）；咳嗽
去参、枣、生姜，加五味子、干姜（咳为气逆肺寒，五味敛肺，干姜散寒。戴元礼曰∶少阳
有嗽无喘，有喘，非少阳也；阳明有喘无嗽，有嗽，非正阳明也）；虚烦加竹叶、粳米（竹
叶凉心，粳米和胃）；齿燥无津加石膏（齿燥属阳明火，石膏清胃止渴）；痰多加栝蒌、贝母
（能去热痰）；腹痛去黄芩，加芍药（黄芩寒中，芍药合甘草和里）；胁下痞硬去大枣，加牡
蛎（大枣甘令人满，牡蛎咸能软坚）；胁下痛加青皮、芍药（胁为肝胆之部，痛属肝火，二
药平肝）；心下悸、小便不利，去黄芩、加茯苓（经曰∶太阳证饮水多，心下必悸，水停心
下故悸，水蓄不行，故小便不利，黄芩苦，反坚肾，茯苓淡，能利水）；本经头痛加川芎（入
肝活血，散郁除风）；发黄加茵陈（利湿）。
此足少阳药也。胆为清净之府，无出无入，其经在半表半里，不可汗吐下，法宜和解（仲
景曰∶少阳中风，耳聋目赤、胸满而烦、不可吐下，吐下则悸而惊。又曰∶伤寒脉弦细，头
痛发
语）。邪入本经，乃由表而将至里，当彻热发表，迎而夺之，勿令传太阴。柴胡味苦微寒，
少阳主药，以升阳达表，为君；黄芩苦寒，以养阴退热，为臣（阳不足则阴凑之，故发寒，
用黄芩降阴气，使不陷入阳中，则不寒；阴不足则阳凑之，故发热，用柴胡升阳气，使不陷
入阴中，则不热。又曰∶柴胡、黄芩之苦寒以退热，半夏、生姜之辛温以退寒，人参、大枣、
甘草之甘温以助正气）；半夏辛温，能健脾和胃，以散逆气而止呕；人参、甘草，以补正气
而和中，使邪不得复传入里，为佐（二药固太阴，使木邪不致克土，然必虚人方可用参）；
邪在半表半里，则营卫争（表属卫，里属营），故用姜枣之辛甘以和营卫，为使也（李时珍
曰∶少阳证虽在半表半里，而胸膈痞满，实兼心肺上焦之邪，心烦喜呕，默默不欲食，又兼
脾胃中焦之证，故用黄芩以治手足少阳相火，黄芩亦少阳药也。昂按∶半夏止呕和胃健脾，
亦通治烦呕不欲食，寒热间作，脾亦有之，不独少阳也，小柴胡之用半夏，以邪在半表半里，
则阴阳争，用半夏和胃而通阴阳也，《灵枢经》用治不眠，亦同此意。而仲景治喉痹咽痛及
大小便秘，皆用半夏，取其辛能润燥，又能散也。丹溪谓半夏能使大便润而小便长，今又专
以半夏为除痰之药，稍涉燥证，辄不敢用。而半夏之功用不复见知于世矣。徐忠可曰∶小柴
胡能引清气而行阳道，能引胃气上行而行春令，能散诸经血凝气聚，故凡邪在表里混杂者，
俱藉之以提出少阳，俾循经而散，以柴甘生姜为定药，余则加减随证耳。陶节庵曰∶本经证
心下饱闷，未经下者，非结胸也，乃表邪传至胸中，未入于腑，尚为在表，只须小柴胡加枳
桔，不效，就以本方兑小陷胸加枳桔，一服豁然，其效如神。喻嘉言曰∶伤寒分表里中三治，
表里之邪俱盛，则从中而和之，故有小柴胡之和法，用人参、甘草、半夏、生姜、大枣助脾
和中，但带柴胡一味透表，黄芩一味透里。饮入胃中，听胃气之升者，带柴胡出表；胃气之
降者，带黄芩入里；一和而表里之邪尽服，未尽者加工治之，不相捍格矣。又曰∶虚劳发寒
热者，乃卫虚则恶寒，营虚则发热耳，缓调营卫，俾不亢战，寒热自止；若误用小柴胡，俾
汗多而卫伤于外，便溏而营伤于内，虚热转加，病益甚矣。吴绶曰∶小柴胡为半表半里之剂，
太阳经之表热，阳明经之标热，皆不能解也。若夫阳气虚寒，面赤发热，脉沉足冷者，服之
立见危殆；及内有虚寒，大便不实，妇人新产发热，皆不可用也。李士材曰∶今人治伤寒，
不分阴阳表里，概用此方去参投之，以为平稳，杀人多矣，不独峻剂也。李东垣曰∶若血受
病，亦先调气，谓气不调则血不行，气夫血妇也，如妇人经病，先柴胡以行经之表，次四物
以行经之里，亦先气而后血也）。
本方以前胡代柴胡，名小前胡汤（崔氏）∶治同（胡洽云∶亦仲景方）。本方加陈皮、芍
药，名柴胡双解散（节庵）∶治同。本方加芒硝，名柴胡加芒硝汤（仲景。见表里门），本方
加桂枝，名柴胡加桂枝汤（仲景）∶治伤寒六七日，发热微恶寒，支节烦痛，微呕，心下支
结，外证未去者（伤寒六七日，邪当传里；支结者，胸中支撑而结也。喻嘉言曰∶谓结于心
之边旁也。呕而支结，为将传里；发热恶寒，骨节烦痛。为外证未除。昂按∶此兼太阳，故
加桂枝，脉经曰，发汗多亡阳谵语，不可下，宜此汤和其营卫以通津液，自愈）。本方除黄
芩、甘草，加桂枝、茯苓、龙骨、牡蛎、铅丹、大黄，名柴胡加龙骨牡蛎汤（仲景）∶治伤
寒八九日，下之腹满烦惊。小便不利，谵语，身重不可转侧（伤寒八九日，过经然后下之，
可谓慎矣。孰知外邪未尽，乘虚入里，烦满者，阳热入胸也；惊者，心恶热而神不守也；烦
惊虽系乎心，亦因胆虚，为将军之官失荣而多畏也；小便不利，里虚而津液不行也；谵语，
胃热也；身重不可转侧，阳气不营于表也；与柴胡汤以除烦满；加茯苓、龙骨、牡蛎、铅丹，
收敛神气而镇惊，而茯苓、牡蛎又能行津液、利小便；加大黄以逐胃热，止谵语；加桂枝以
行阳气；合柴胡以散表邪而解身重；因满故去甘草。按∶伤寒传足不传手，其实原无界限，
此证邪热干心，神明内乱，故致烦惊谵语，仲景加入心药数种，不专以足经之治治之也）。
本方去半夏、人参、姜、枣，加桂枝、干姜、花粉、牡蛎，名柴胡桂枝干姜汤（仲景）∶治
伤寒汗下后，胸胁满，微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者（头汗寒
热而兼满渴，表里皆有邪，故除人参、半夏，而加桂枝以解太阳。干姜以散满，花粉以生津，
牡蛎以软坚，以此和解，复津液而助阳；亦治疟发寒多热少，或但寒不热喻嘉言曰∶小柴胡
本阴阳两停之方，可从寒热以为进退，此方加姜桂则进而从阳，其加芩连以退而从阴，可以
类推。李 曰∶伤寒余热未尽，重感六淫之气，变而为疟，治法与杂病不同，寒多热少，或
单寒者，太阳邪变也，柴胡桂枝汤；热多寒少，或单热，骨节烦痛者，阳明邪变也，白虎汤
加桂；寒热相等，或先热者，少阳邪变也，小柴胡汤，渴者去半夏，加花粉、知母；寒热大
作，战栗汗出不散者，太阳阳明合病也，桂枝石膏汤。服止后疟愈甚者，三阳合病也，恐传
入阴经，从卯至午，发而呕吐，大便闭者，大柴胡汤下之；从午至酉，发而腹满便闭者，大
承气汤下之；从酉至寅，发而欲狂善忘便黑者，桃仁承气汤微利之；不敢下者，栀子升麻汤；
若挟痰食瘴气，治法与杂病略同。附桂枝石膏汤∶桂枝一钱，黄芩二钱，石膏、知母各三钱。
桂枝黄芩汤∶即小柴胡加石膏二钱、知母二钱、桂枝五分。李 曰∶二方以桂枝治太阳，白
虎治阳明，柴胡治少阳，意甚明显，挟痰合二陈，食积合平胃，溺涩合五苓，便闭合大柴胡，
无汗加葛根、苍术，有汗加黄 、白术，夜发加白芍、桃仁，日久加常山、槟榔吐之；治疟
之法尽矣。本方去半夏，加花粉，名柴胡去半夏加栝蒌根汤金匮∶治往来寒热而渴，及劳疟
花粉润燥生津。太阳小便不利而渴，宜五苓；阳明大便不利而渴，宜调胃承气、大柴胡；已
利而渴，宜白虎；少阳寒热往来而渴，宜此汤。遇劳即发，名劳疟）。本方去柴胡、黄芩，
加浓朴，名浓朴生姜半夏甘草人参汤（仲景）∶治发汗后腹胀满者（凡吐下后胀满者，乃当
汗不汗，误与吐下，表邪乘虚入里，邪气盛则实之证也；汗后表已解而胀满者，知非里实，
缘脾胃气虚、阴气内壅而为胀也，法当补虚散滞）。本方除半夏，加当归、白芍、大黄，名
柴胡饮子子和∶治肌热、蒸热、积热，汗后余热，脉洪实弦数（表为肌热，里为蒸热，壅为
积热）；亦治疟疾（喻嘉言曰∶子和法中略施攻补，深中肯綮）。本方加羌活、防风，名柴胡
羌活汤，治温疫少阳证。本方加桔梗，名柴胡桔梗汤∶治春嗽。本方合平胃散，名柴平汤∶
治湿疟身痛身重。本方加青黛，姜汁糊丸，名清镇丸（洁古）∶治呕吐脉弦头痛及热嗽。本
方一分，加四物二分，名柴胡四物汤∶治妇人日久虚劳，微有寒热。本方与四物各半，名调
经汤。
（张仲景）
治疗伤寒中风少阳证，症状表现为寒热往来，胸胁部痞塞满闷，神情沉默不欲饮食，心烦且容易呕吐；或者腹中疼痛，或者胁下疼痛，或者口渴，或者咳嗽，或者腹泻，或者心悸，小便不通利，口苦耳聋，脉象弦；或者是发汗后余热未清；以及春季的时行咳嗽，疟疾发作时的寒热交替，妇女伤寒热邪陷入血室（寒为阴，热为阳；里为阴，表为阳；邪气客居在半表半里之间，阴气外出与阳气相争，阴胜则恶寒；阳气内入与阴气相争，阳胜则发热；阳气不足则先感到寒冷，阴气不足则先感到发热。又说：太阳经行于身体背部，属膀胱寒水，主表；阳明经行于身体前部，属胃燥金，是表的里层；邪气停留在中间，靠近后方膀胱水则恶寒，靠近前方阳明燥则发热。寒热有固定时间的是疟疾，没有固定时间的是寒热往来，因为热在表而浅，邪气与正气相争所以畏寒，寒罢之后又发热，这是邪气尚未并入表或里，所以寒热轻微且无定时。半表半里，属于足少阳胆经，循行于两胁，手少阳三焦经脉络于心包，风邪侵犯它，心气不能宣畅，所以烦闷，或者攻冲胸胁，所以又有胸胁痛。邪气在表则呻吟不安，在里则烦闷扰乱，邪气从表刚传入里，所以神情沉默安静。经文说：阳入于阴则静，邪气在表则能进食，入里则不能进食，现在处于表里之间，所以只是不想吃东西，还没到完全不能吃的程度。邪气在表则不烦不呕，在里则烦呕，表刚传里，所以心烦喜呕。里虚兼有热邪，所以有时口渴有时腹泻，有时腹中痛；里有停饮，所以心悸而小便不利；少阳胆经脉络于耳，所以耳聋；胆气上溢，所以口苦；胆与肝都属木，所以脉弦；春季的时行咳嗽，是少阳当令的时候。血室，就是冲脉，男女都有，妇女患伤寒七八天，邪气应当传入里，正值月经来潮，则邪气不入腑，乘虚进入血室；或者月经刚断，表邪乘虚也进入血室，热与血搏结而不行，导致有寒热如疟疾，傍晚时胡言乱语如见鬼状，在男子则是下血谵语，都称为热入血室。妇女伤寒与男子无异，只有热入血室、妊娠伤寒是不同的。小柴胡汤在经主治气，在脏主治血，所以更能进入血室。经文说：伤寒中风，有柴胡证，只要见到一个证候就可以，不必全部具备。又说：伤寒五六天，发热而呕，医生用其他药攻下，柴胡证仍在的，再给柴胡汤，必定会蒸蒸而振栗，发热出汗而痊愈。或者是湿热在半表半里而发黄的，仍给小柴胡汤调和表里，即使是杂病也不能例外；也治疗伤寒五六天，头出汗，微恶寒，手脚冷，心下满，不想吃东西，大便硬，脉细的，这是阳微结。张仲景说：出汗为阳微，假如是纯阴结，不得再有外证，脉虽然沉紧，不能诊断为少阴病，之所以这样，是因为阴证不得有汗，现在头有汗，所以知道不是少阴病。按：三阴脉都到达颈、胸中而返回，不上行头部。程郊倩说：热虽然结聚但不严重，因为有微恶寒的半表证存在，至于脉沉，虽然像里阴，但又有头汗出的证候来区别它，凡是脉细、脉沉、脉紧，都是阳热郁结的证候，与少阴无关，可见阳气一结，不但阳证像阴，阳脉也像阴了）。
柴胡（八两） 半夏（半升） 人参 甘草 黄芩 生姜（三两） 大枣（十二枚）。
呕吐逆气加生姜、陈皮（生姜散逆气，陈皮顺气）；心烦而不呕吐去掉半夏、人参，加栝蒌（以清除郁热）；
口渴的去掉半夏，加花粉（生津液）；如果不渴，体表有微热，去掉人参，加桂枝覆盖取微汗（解肌）；咳嗽去掉参、枣、生姜，加五味子、干姜（咳嗽是气逆肺寒，五味子敛肺，干姜散寒。戴元礼说：少阳有嗽无喘，有喘就不是少阳；阳明有喘无嗽，有嗽就不是正阳明）；虚烦加竹叶、粳米（竹叶凉心，粳米和胃）；牙齿干燥无津液加石膏（牙齿干燥属阳明火，石膏清胃止渴）；痰多加栝蒌、贝母（能去热痰）；腹痛去掉黄芩，加芍药（黄芩寒中，芍药合甘草调和里）；胁下痞硬去掉大枣，加牡蛎（大枣甘令人满，牡蛎咸能软坚）；胁下痛加青皮、芍药（胁是肝胆的部位，痛属肝火，二药平肝）；心下悸、小便不利，去掉黄芩、加茯苓（经文说：太阳证饮水多，心下必悸，水停心下故悸，水蓄不行，故小便不利，黄芩苦，反坚肾，茯苓淡，能利水）；本经头痛加川芎（入肝活血，散郁除风）；发黄加茵陈（利湿）。
这是足少阳的药。胆为清净之府，无出无入，其经在半表半里，不可用汗、吐、下法，治法宜和解（张仲景说：少阳中风，耳聋目赤、胸满而烦、不可吐下，吐下则悸而惊。又说：伤寒脉弦细，头痛发语）。邪气进入本经，是由表将至里，应当彻热发表，迎而夺之，不要让它传入太阴。柴胡味苦微寒，是少阳的主药，用以升阳达表，作为君药；黄芩苦寒，用以养阴退热，作为臣药（阳气不足则阴气凑之，所以发寒，用黄芩降阴气，使不陷入阳中，则不寒；阴气不足则阳气凑之，所以发热，用柴胡升阳气，使不陷入阴中，则不热。又说：柴胡、黄芩的苦寒以退热，半夏、生姜的辛温以退寒，人参、大枣、甘草的甘温以助正气）；半夏辛温，能健脾和胃，以散逆气而止呕；人参、甘草，用以补正气而和中，使邪气不得再次传入里，作为佐药（这两味药固护太阴，使木邪不致克土，但必须是虚人方可用人参）；邪在半表半里，则营卫相争（表属卫，里属营），所以用姜枣的辛甘以和营卫，作为使药（李时珍说：少阳证虽在半表半里，而胸膈痞满，实兼心肺上焦之邪，心烦喜呕，默默不欲食，又兼脾胃中焦之证，所以用黄芩以治手足少阳相火，黄芩也是少阳药。汪昂按：半夏止呕和胃健脾，也通治烦呕不欲食，寒热间作，脾也有这种情况，不独少阳也，小柴胡之用半夏，是因为邪在半表半里，则阴阳争，用半夏和胃而通阴阳，《灵枢经》用它治不眠，也是同样的意思。而且张仲景治喉痹咽痛及大小便秘，都用半夏，取其辛能润燥，又能散。丹溪说半夏能使大便润而小便长，现在又专把半夏当作除痰的药，稍微涉及燥证，就不敢用。而半夏的功效不再被世人所知。徐忠可说：小柴胡能引清气而行阳道，能引胃气上行而行春令，能散诸经血凝气聚，所以凡是邪气在表里混杂的，都借它提出少阳，使其循经而散，以柴胡、甘草、生姜为定药，其余则加减随证而已。陶节庵说：本经证心下饱闷，未经攻下的，不是结胸，乃是表邪传至胸中，未入于腑，尚为在表，只需小柴胡加枳桔，无效，就用本方兑小陷胸加枳桔，一服豁然，其效如神。喻嘉言说：伤寒分表里中三治，表里之邪俱盛，则从中而和之，所以有小柴胡之和法，用人参、甘草、半夏、生姜、大枣助脾和中，只带柴胡一味透表，黄芩一味透里。饮入胃中，听胃气之升者，带柴胡出表；胃气之降者，带黄芩入里；一和而表里之邪尽服，未尽者加工治之，不相捍格了。又说：虚劳发寒热的，是卫虚则恶寒，营虚则发热耳，缓调营卫，使其不亢战，寒热自止；如果误用小柴胡，使其汗多而卫伤于外，便溏而营伤于内，虚热转加，病益甚矣。吴绶说：小柴胡为半表半里之剂，太阳经之表热，阳明经之标热，都不能解。如果是阳气虚寒，面赤发热，脉沉足冷的，服用它立即见危殆；以及内有虚寒，大便不实，妇人新产发热，都不可用。李士材说：现在人治伤寒，不分阴阳表里，一概用此方去参投之，以为平稳，杀人很多了，不只是峻剂。李东垣说：如果血受病，也先调气，谓气不调则血不行，气夫血妇也，如妇人经病，先柴胡以行经之表，次四物以行经之里，也是先气而后血）。
本方以前胡代柴胡，名小前胡汤（崔氏）：治疗同（胡洽说：也是张仲景方）。本方加陈皮、芍药，名柴胡双解散（节庵）：治疗同。本方加芒硝，名柴胡加芒硝汤（张仲景。见表里门），本方加桂枝，名柴胡加桂枝汤（张仲景）：治疗伤寒六七天，发热微恶寒，肢体关节烦痛，微呕，心下支结，外证未去的（伤寒六七天，邪气应当传里；支结者，胸中支撑而结也。喻嘉言说：谓结于心之边旁也。呕而支结，为将传里；发热恶寒，骨节烦痛。为外证未除。汪昂按：此兼太阳，所以加桂枝，脉经说，发汗多亡阳谵语，不可下，宜此汤和其营卫以通津液，自愈）。本方除黄芩、甘草，加桂枝、茯苓、龙骨、牡蛎、铅丹、大黄，名柴胡加龙骨牡蛎汤（张仲景）：治疗伤寒八九天，攻下后腹满烦惊。小便不利，谵语，身重不可转侧（伤寒八九天，过经然后下之，可谓谨慎了。谁知道外邪未尽，乘虚入里，烦满者，阳热入胸也；惊者，心恶热而神不守也；烦惊虽系乎心，也因胆虚，为将军之官失荣而多畏也；小便不利，里虚而津液不行也；谵语，胃热也；身重不可转侧，阳气不营于表也；给柴胡汤以除烦满；加茯苓、龙骨、牡蛎、铅丹，收敛神气而镇惊，而茯苓、牡蛎又能行津液、利小便；加大黄以逐胃热，止谵语；加桂枝以行阳气；合柴胡以散表邪而解身重；因满所以去甘草。按：伤寒传足不传手，其实原无界限，此证邪热干心，神明内乱，所以致烦惊谵语，张仲景加入心药数种，不专以足经之治治之也）。
本方去半夏、人参、姜、枣，加桂枝、干姜、花粉、牡蛎，名柴胡桂枝干姜汤（张仲景）：治疗伤寒汗下后，胸胁满，微结，小便不利，渴而不呕，但头汗出，往来寒热，心烦者（头汗寒热而兼满渴，表里皆有邪，所以除人参、半夏，而加桂枝以解太阳。干姜以散满，花粉以生津，牡蛎以软坚，以此和解，复津液而助阳；也治疗疟疾发作寒多热少，或但寒不热。喻嘉言说：小柴胡本是阴阳两停之方，可从寒热以为进退，此方加姜桂则进而从阳，其加芩连以退而从阴，可以类推。李 说：伤寒余热未尽，重感六淫之气，变而为疟，治法与杂病不同，寒多热少，或单寒者，太阳邪变也，柴胡桂枝汤；热多寒少，或单热，骨节烦痛者，阳明邪变也，白虎汤加桂；寒热相等，或先热者，少阳邪变也，小柴胡汤，渴者去半夏，加花粉、知母；寒热大作，战栗汗出不散者，太阳阳明合病也，桂枝石膏汤。服止后疟愈甚者的，三阳合病也，恐传入阴经，从卯至午，发而呕吐，大便闭者，大柴胡汤下之；从午至酉，发而腹满便闭者，大承气汤下之；从酉至寅，发而欲狂善忘便黑者，桃仁承气汤微利之；不敢下的，栀子升麻汤；如果挟痰食瘴气，治法与杂病略同。附桂枝石膏汤：桂枝一钱，黄芩二钱，石膏、知母各三钱。桂枝黄芩汤：即小柴胡加石膏二钱、知母二钱、桂枝五分。李 说：二方以桂枝治太阳，白虎治阳明，柴胡治少阳，意甚明显，挟痰合二陈，食积合平胃，溺涩合五苓，便闭合大柴胡，无汗加葛根、苍术，有汗加黄芪、白术，夜发加白芍、桃仁，日久加常山、槟榔吐之；治疟之法尽矣。本方去半夏，加花粉，名柴胡去半夏加栝蒌根汤金匮：治疗往来寒热而渴，及劳疟花粉润燥生津。太阳小便不利而渴，宜五苓；阳明大便不利而渴，宜调胃承气、大柴胡；已利而渴，宜白虎；少阳寒热往来而渴，宜此汤。遇劳即发，名劳疟）。本方去柴胡、黄芩，加浓朴，名浓朴生姜半夏甘草人参汤（张仲景）：治疗发汗后腹胀满者（凡吐下后胀满者，乃当汗不汗，误与吐下，表邪乘虚入里，邪气盛则实之证也；汗后表已解而胀满者，知非里实，缘脾胃气虚、阴气内壅而为胀也，法当补虚散滞）。本方除半夏，加当归、白芍、大黄，名柴胡饮子子和：治疗肌热、蒸热、积热，汗后余热，脉洪实弦数（表为肌热，里为蒸热，壅为积热）；也治疗疟疾（喻嘉言说：子和法中略施攻补，深中肯綮）。本方加羌活、防风，名柴胡羌活汤，治疗温疫少阳证。本方加桔梗，名柴胡桔梗汤：治疗春嗽。本方合平胃散，名柴平汤：治疗湿疟身痛身重。本方加青黛，姜汁糊丸，名清镇丸（洁古）：治疗呕吐脉弦头痛及热嗽。本方一分，加四物二分，名柴胡四物汤：治疗妇人日久虚劳，微有寒热。本方与四物各半，名调经汤。
(Zhang Zhongjing)
Treats Shaoyang syndrome (Shaoyang Syndrome) of Shanghan (Cold Damage) and Fengzhong (Wind Strike), with symptoms of alternating chills and fever, chest and hypochondriac fullness and oppression, silent desire not to eat, irritability and frequent vomiting; or abdominal pain, or hypochondriac pain, or thirst, or cough, or diarrhea, or palpitations, dysuria, bitter taste in the mouth, deafness, wiry pulse; or residual heat after sweating; as well as seasonal cough in spring, malaria with alternating chills and fever, and women's Shanghan with heat entering the Blood Chamber (Blood Chamber refers to the Chong Mai vessel where pathogenic factors may enter during menstruation). (Chill is Yin, Fever is Yang; Interior is Yin, Exterior is Yang; Pathogen lodges between Exterior and Interior. When Yin goes out to contend with Yang, Yin excess causes chills; when Yang enters to contend with Yin, Yang excess causes fever. If Yang is insufficient, chills appear first; if Yin is insufficient, fever appears first. Furthermore: The Taiyang channel runs along the back, belongs to Bladder Cold Water, and governs the Exterior; the Yangming channel runs along the front, belongs to Stomach Dry Metal, and is the Interior of the Exterior. Pathogen staying in the middle, closer to the posterior Bladder Water causes chills, closer to the anterior Yangming Dryness causes fever. Chills and fever with fixed timing are Malaria; without fixed timing is alternating chills and fever, because the heat is superficial in the Exterior, and the pathogen contends with healthy Qi causing aversion to cold. After chills subside, fever returns. This indicates the pathogen has not merged into the Exterior or Interior, so chills and fever are mild and untimed. The half-Exterior half-Interior belongs to the Foot-Shaoyang Gallbladder Meridian, running through the hypochondrium. The Hand-Shaoyang Sanjiao Meridian connects to the Pericardium. Wind pathogen invades it, Heart Qi cannot circulate freely, causing irritability and fullness, or attacking the chest and hypochondrium, hence chest and hypochondriac pain. Pathogen in the Exterior causes groaning and restlessness; in the Interior causes irritability and confusion. As pathogen moves from Exterior to Interior, the patient becomes silent and quiet. The Classic states: Yang entering Yin results in quietness. Pathogen in the Exterior allows eating; in the Interior prevents eating. Now being between Exterior and Interior, there is merely lack of desire to eat, not complete inability to eat. Pathogen in the Exterior causes no irritability or vomiting; in the Interior causes irritability and vomiting. As table transmits to interior, there is irritability and preference for vomiting. Interior deficiency with協 Heat causes occasional thirst or diarrhea, or abdominal pain; Fluid retention in the Interior causes palpitations and dysuria; Shaoyang Gallbladder meridian connects to the ear, causing deafness; Gallbladder Qi overflowing upward causes bitter taste; Gallbladder and Liver both belong to Wood, hence wiry pulse; Seasonal cough in spring occurs when Shaoyang is dominant. The Blood Chamber is the Chong Mai, present in both men and women. In women with Shanghan for seven to eight days, pathogen should transmit to Interior, but if menstruation arrives, pathogen does not enter the Fu organs but enters the Blood Chamber due to deficiency. Or if menstruation just stopped, exterior pathogen also enters Blood Chamber due to deficiency. Heat and Blood struggle and stagnate, causing chills and fever like malaria, delirium at dusk as if seeing ghosts. In men, it presents as bloody stool and delirium, all termed Heat Entering Blood Chamber. Women's Shanghan is no different from men's, except for Heat Entering Blood Chamber and pregnancy Shanghan. Xiao Chai Hu Tang acts on Qi in the Meridians and Blood in the Zang organs, thus able to enter the Blood Chamber. The Classic states: In Shanghan or Fengzhong, if Chai Hu syndrome exists, seeing one symptom is sufficient, not all need to be present. Also: After five to six days of Shanghan, with fever and vomiting, if a physician purges with other medicines and Chai Hu syndrome persists, administering Chai Hu Decoction again will cause shivering and shaking, followed by fever and sweating, leading to recovery. For damp-heat in half-Exterior half-Interior causing jaundice, still administer Xiao Chai Hu Tang to harmonize Exterior and Interior; this applies even to miscellaneous diseases. It also treats Shanghan after five to six days, with head sweating, slight aversion to cold, cold hands and feet, epigastric fullness, lack of desire to eat, hard stool, and fine pulse, known as Yang Wei Jie (Yang Slight Knotting). Zhang Zhongjing said: Sweating indicates Yang Wei. If it were pure Yin Jie, there would be no exterior signs. Even with deep-tight pulse, it cannot be Shaoyin disease. Why? Because Yin patterns do not sweat. Since there is head sweating, we know it is not Shaoyin. Note: The Three Yin meridians reach the neck and chest and return, not ascending to the head. Cheng Jiaoqian said: Although heat is knotted, it is not severe, as there is slight aversion to cold indicating half-Exterior involvement. Regarding deep pulse, although resembling Interior Yin, the head sweating distinguishes it. Fine, deep, and tight pulses are all signs of knotted Yang heat, unrelated to Shaoyin. Thus, once Yang Qi is knotted, not only Yang patterns resemble Yin, but Yang pulses also resemble Yin.)
Chai Hu (Cortex Bupleuri) (8 liang), Ban Xia (Rhizoma Pinelliae) (0.5 sheng), Ren Shen (Radix Ginseng), Gan Cao (Radix Glycyrrhizae), Huang Qin (Radix Scutellariae), Sheng Jiang (Rhizoma Zingiberis Recens) (3 liang), Da Zao (Fructus Jujubae) (12 pieces).
For vomiting and rebellious Qi, add Sheng Jiang and Chen Pi (Sheng Jiang disperses rebellious Qi, Chen Pi regulates Qi); for irritability without vomiting, remove Ban Xia and Ren Shen, add Gua Lou (to clear stagnant heat);
for thirst, remove Ban Xia, add Hua Fen (to generate fluids); if no thirst but slight exterior heat, remove Ren Shen, add Gui Zhi (Cortex Cinnamomi) to cover and induce slight sweating (release muscle layer); for cough, remove Ren Shen, Da Zao, Sheng Jiang, add Wu Wei Zi (Fructus Schisandrae) and Gan Jiang (Rhizoma Zingiberis) (cough is rebellious Qi and Lung cold, Wu Wei Zi astringes Lung, Gan Jiang dispels cold. Dai Yuanli said: Shaoyang has cough but no wheezing; wheezing is not Shaoyang. Yangming has wheezing but no cough; cough is not proper Yangming); for deficiency irritability, add Zhu Ye (Folium Bambusae) and Jing Mi (Semen Oryzae Sativum) (Zhu Ye cools Heart, Jing Mi harmonizes Stomach); for dry teeth without saliva, add Shi Gao (Gypsum Fibrosum) (dry teeth belong to Yangming fire, Shi Gao clears Stomach and stops thirst); for excessive phlegm, add Gua Lou and Bei Mu (can eliminate hot phlegm); for abdominal pain, remove Huang Qin, add Shao Yao (Paeoniae Radix Alba) (Huang Qin is cold in the middle, Shao Yao combined with Gan Cao harmonizes Interior); for hypochondriac fullness and hardness, remove Da Zao, add Mu Li (Concha Ostreae) (Da Zao is sweet causing fullness, Mu Li is salty softening hardness); for hypochondriac pain, add Qing Pi (Pericarpium Citri Reticulatae Viride) and Shao Yao (hypochondrium is the region of Liver and Gallbladder, pain belongs to Liver fire, these two herbs calm Liver); for epigastric palpitations and dysuria, remove Huang Qin, add Fu Ling (Poria) (Classic says: In Taiyang pattern, drinking too much water causes epigastric palpitations; water stopping in epigastrium causes palpitations; water accumulation prevents urination. Huang Qin is bitter and hardens Kidney, Fu Ling is bland and promotes urination); for headache in this meridian, add Chuan Xiong (Rhizoma Ligustici Chuanxiong) (enters Liver, invigorates blood, disperses stagnation and wind); for jaundice, add Yin Chen (Herba Artemisiae Scopariae) (promotes dampness drainage).
This is a formula for the Foot-Shaoyang. Gallbladder is the organ of purity and clarity, having no exit or entry, its meridian is in half-Exterior half-Interior. Sweat, emesis, and purge methods are contraindicated; the treatment method should be Harmonization (Zhang Zhongjing said: Shaoyang Fengzhong presents with deafness, red eyes, chest fullness and irritability; emesis and purge are contraindicated, as they cause palpitations and fright. Also: Shanghan with wiry-thin pulse, headache, and speaking in sleep). Pathogen entering this meridian comes from Exterior approaching Interior. One should thoroughly clear heat and release Exterior, intercept and seize it, preventing transmission to Taiyin. Chai Hu is bitter and slightly cold, the principal herb for Shaoyang, used to raise Yang and reach Exterior, serving as Jun (Monarch) herb; Huang Qin is bitter and cold, used to nourish Yin and reduce fever, serving as Chen (Minister) herb (Insufficient Yang allows Yin to gather, causing chills; Huang Qin lowers Yin Qi, preventing it from sinking into Yang, thus stopping chills. Insufficient Yin allows Yang to gather, causing fever; Chai Hu raises Yang Qi, preventing it from sinking into Yin, thus stopping fever. Also: The bitterness and coldness of Chai Hu and Huang Qin reduce fever; the pungency and warmth of Ban Xia and Sheng Jiang reduce chills; the sweetness and warmth of Ren Shen, Da Zao, and Gan Cao assist healthy Qi). Ban Xia is pungent and warm, strengthens Spleen and harmonizes Stomach, dissipates rebellious Qi and stops vomiting; Ren Shen and Gan Cao tonify healthy Qi and harmonize Middle, preventing pathogen from re-entering Interior, serving as Zuo (Assistant) herbs (These two secure Taiyin, preventing Wood pathogen from overacting on Earth, but Ren Shen should only be used for deficient patients). Pathogen in half-Exterior half-Interior causes Ying and Wei contention (Exterior belongs to Wei, Interior belongs to Ying), so Ginger and Jujube's pungent-sweet nature harmonizes Ying and Wei, serving as Shi (Envoy) herb (Li Shizhen said: Although Shaoyang pattern is in half-Exterior half-Interior, chest and diaphragm fullness actually involves pathogen in Upper Jiao of Heart and Lungs; irritability, frequent vomiting, and silent anorexia involve Middle Jiao of Spleen and Stomach. Thus Huang Qin is used to treat Minister Fire of Hand and Foot Shaoyang; Huang Qin is also a Shaoyang herb. Wang Ang notes: Ban Xia stops vomiting, harmonizes Stomach, strengthens Spleen, and generally treats irritability, vomiting, anorexia, and alternating chills/fever involving Spleen, not exclusive to Shaoyang. Xiao Chai Hu uses Ban Xia because pathogen in half-Exterior half-Interior causes Yin-Yang contention; Ban Xia harmonizes Stomach and connects Yin-Yang. Ling Shu Jing uses it for insomnia, same intent. Zhang Zhongjing uses Ban Xia for throat obstruction, sore throat, and constipation/diarrhea, taking advantage of its pungency to moisten dryness and disperse. Danxi said Ban Xia moistens bowels and lengthens urine. Now it is specialized as a phlegm-resolving herb, avoided in dryness patterns. Its functions are unknown. Xu Zhongke said: Xiao Chai Hu draws clear Qi to travel the Yang pathway, draws Stomach Qi upward to follow Spring command, disperses blood stasis and Qi aggregation in various meridians. Thus for pathogen mixed in Exterior and Interior, it helps extract to Shaoyang to scatter along the meridian. Chai Hu, Gan Cao, Sheng Jiang are fixed herbs; others are modified according to syndrome. Tao Jian'an said: In meridian pattern with epigastric fullness, if not yet purged, it is not Jie Xiong (Chest Binding), but exterior pathogen transmitted to chest, not yet in Fu organs, still in Exterior. Only need Xiao Chai Hu plus Zhi Jie. If ineffective, mix Ben Fang with Xiao Xian Xiong plus Zhi Jie, one dose brings sudden relief, efficacy like spirit. Yu Jiayan said: Shanghan divides treatment into Exterior, Interior, and Middle. When Exterior and Interior pathogens are both abundant, harmonize from the Middle, hence Xiao Chai Hu Harmonizing Method. Using Ren Shen, Gan Cao, Ban Xia, Sheng Jiang, Da Zao to assist Spleen and harmonize Middle, carrying only Chai Hu one herb to penetrate Exterior, Huang Qin one herb to penetrate Interior. Upon ingestion, Stomach Qi rising carries Chai Hu out of Exterior; Stomach Qi descending carries Huang Qin into Interior. One harmonization clears Exterior and Interior pathogens; remaining ones receive further treatment, without conflict. Also: Deficiency consumption with chills and fever is Wei deficiency causing chills, Ying deficiency causing fever. Slowly regulate Ying and Wei to prevent hyperactivity and combativeness, chills and fever stop naturally. Mistaken use of Xiao Chai Hu causes excessive sweating injuring Wei externally, loose stools injuring Ying internally, deficiency heat increases, disease worsens. Wu Shou said: Xiao Chai Hu is a half-Exterior half-Interior agent, unable to resolve Taiyang Exterior heat or Yangming Mark heat. If Yang Qi is deficient and cold, with red face, fever, deep pulse, cold feet, taking it leads to immediate danger. Internal deficiency cold, loose stools, postpartum fever in women are all contraindications. Li Shicai said: Modern physicians treating Shanghan without distinguishing Yin/Yang or Exterior/Interior generally use this formula removing Ren Shen, thinking it safe, killing many, not just harsh agents. Li Dongyuan said: If Blood is diseased, first regulate Qi, for unregulated Qi means Blood cannot flow. Qi is husband, Blood is wife. For women's menstrual disease, first use Chai Hu to move Exterior of meridian, then Si Wu Tang to move Interior of meridian, prioritizing Qi before Blood).
Replacing Chai Hu with Qian Hu in this formula is named Xiao Qian Hu Tang (Cui Shi): Treats same (Hu Qia says: Also Zhang Zhongjing's formula). Adding Chen Pi and Shao Yao to this formula is named Chai Hu Shuang Jie San (Jie An): Treats same. Adding Mang Xiao to this formula is named Chai Hu Jia Mang Xiao Tang (Zhang Zhongjing. See Exterior-Interior section). Adding Gui Zhi to this formula is named Chai Hu Jia Gui Zhi Tang (Zhang Zhongjing): Treats Shanghan six to seven days, fever with slight aversion to cold, limb joint vexing pain, slight vomiting, epigastric branch-knotting, exterior signs unresolved (Shanghan six to seven days, pathogen should transmit to Interior; Branch-knotting means support and knotting in chest. Yu Jiayan said: Knotting at the side of Heart. Vomiting with branch-knotting indicates impending transmission to Interior; fever, aversion to cold, bone-joint vexing pain indicate exterior signs remain. Wang Ang notes: This combines Taiyang, hence adding Gui Zhi. Pulse Classic says: Excessive sweating leads to Yang loss and delirium, cannot purge, suitable for this Tang to harmonize Ying and Wei to circulate fluids, self-heals). Removing Huang Qin and Gan Cao, adding Gui Zhi, Fu Ling, Long Gu, Mu Li, Qian Dan, Da Huang to this formula is named Chai Hu Jia Long Gu Mu Li Tang (Zhang Zhongjing): Treats Shanghan eight to nine days, after purging, abdominal fullness, irritability and fright. Dysuria, delirium, body heaviness unable to turn (Shanghan eight to nine days, purging after passing the meridian stage is cautious. Who knew exterior pathogen incomplete, entering Interior due to deficiency? Fullness and irritability: Yang heat enters chest. Fright: Heart fears heat, Spirit does not guard. Irritability and fright relate to Heart, but also due to Gallbladder deficiency, General Officer losing prosperity and fearing much. Dysuria: Interior deficiency, fluids not flowing. Delirium: Stomach heat. Body heaviness unable to turn: Yang Qi not nourishing Exterior. Give Chai Hu Tang to remove fullness and irritability; add Fu Ling, Long Gu, Mu Li, Qian Dan to converge Spirit and calm fright; Fu Ling and Mu Li also circulate fluids and promote urination; add Da Huang to drive Stomach heat, stop delirium; add Gui Zhi to move Yang Qi; combine with Chai Hu to scatter exterior pathogen and relieve body heaviness; remove Gan Cao due to fullness. Note: Shanghan transmits Foot meridians not Hand meridians, actually no boundary. This pattern pathogen heat harasses Heart, Spirit internal chaos causes irritability, fright, delirium. Zhang Zhongjing adds several Heart herbs, not solely treating via Foot meridians).
Removing Ban Xia, Ren Shen, Jiang, Zao, adding Gui Zhi, Gan Jiang, Hua Fen, Mu Li to this formula is named Chai Hu Gui Zhi Gan Jiang Tang (Zhang Zhongjing): Treats Shanghan after sweating and purging, chest and hypochondriac fullness, slight knotting, dysuria, thirst without vomiting, only head sweating, alternating chills and fever, irritability (Head sweating, chills/fever with fullness/thirst, pathogen in both Exterior and Interior, hence remove Ren Shen, Ban Xia, add Gui Zhi to release Taiyang. Gan Jiang to dissipate fullness, Hua Fen to generate fluids, Mu Li to soften hardness. Use this to harmonize, restore fluids and assist Yang; also treats malaria with more chills than fever, or only chills without fever. Yu Jiayan said: Xiao Chai Hu is originally a formula balancing Yin and Yang, can advance/retreat based on chills/fever. This formula adds Jiang and Gui to advance towards Yang; adding Qin and Lian retreats towards Yin, can be inferred similarly. Li [Dongyuan?] said: Residual heat from Shanghan, re-infected by Six Evils, transforms into Malaria. Treatment differs from miscellaneous diseases. More chills than fever, or only chills: Taiyang pathogen transformation, Chai Hu Gui Zhi Tang. More fever than chills, or only fever, bone-joint vexing pain: Yangming pathogen transformation, Bai Hu Tang plus Gui. Equal chills/fever, or fever first: Shaoyang pathogen transformation, Xiao Chai Hu Tang. Thirsty: remove Ban Xia, add Hua Fen, Zhi Mu. Severe chills/fever, shivering sweating not dispersing: Taiyang-Yangming combined disease, Gui Zhi Shi Gao Tang. After stopping medicine, malaria worsens: Three Yang combined disease, fear transmission to Yin meridians. Emitting Mao to Wu, vomiting, closed stool: Da Chai Hu Tang purges. Emitting Wu to You, abdominal fullness, closed stool: Da Cheng Qi Tang purges. Emitting You to Yin, mania, forgetfulness, black stool: Tao Ren Cheng Qi Tang mildly purges. Afraid to purge: Zhi Zi Sheng Ma Tang. If complicated by phlegm-food-miasma, treatment similar to miscellaneous diseases. Attached Gui Zhi Shi Gao Tang: Gui Zhi 1 qian, Huang Qin 2 qian, Shi Gao and Zhi Mu 3 qian each. Gui Zhi Huang Qin Tang: Xiao Chai Hu plus Shi Gao 2 qian, Zhi Mu 2 qian, Gui Zhi 0.5 fen. Li said: These two formulas use Gui Zhi for Taiyang, Bai Hu for Yangming, Chai Hu for Shaoyang, intent very clear. Complicated by phlegm combine Er Chen, food stagnation combine Ping Wei, difficult urination combine Wu Ling, closed stool combine Da Chai Hu, no sweat add Ge Gen, Cang Zhu, sweating add Huang Qi, Bai Zhu, night emission add Bai Shao, Tao Ren, long duration add Chang Shan, Bing Lang to vomit; Malaria treatment exhausted. Removing Ban Xia, adding Hua Fen to this formula is named Chai Hu Qu Ban Xia Jia Gua Lou Gen Tang (Jin Gui): Treats alternating chills/fever with thirst, and Labor Malaria. Hua Fen moistens dryness generates fluids. Taiyang dysuria with thirst: Wu Ling Tang. Yangming constipation with thirst: Tiao Wei Cheng Qi Tang, Da Chai Hu Tang. Diarrhea with thirst: Bai Hu Tang. Shaoyang alternating chills/fever with thirst: This Tang. Emission upon labor called Labor Malaria). Removing Chai Hu, Huang Qin, adding Hou Po to this formula is named Hou Po Sheng Jiang Ban Xia Gan Cao Ren Shen Tang (Zhang Zhongjing): Treats abdominal fullness after sweating (After vomiting/purging, fullness is due to needing sweat but not sweating, mistaken vomiting/purging, exterior pathogen entering Interior due to deficiency, pathogen abundance causing Excess pattern; After sweating, Exterior resolved but fullness remains, know not Interior Excess, due to Spleen-Stomach Qi deficiency, Yin Qi internal blocking causing fullness, method should tonify deficiency and dissipate stagnation). Removing Ban Xia, adding Dang Gui, Bai Shao, Da Huang to this formula is named Chai Hu Yin Zi (Hezi): Treats Muscle Heat, Steaming Heat, Accumulated Heat, residual heat after sweating, surging-solid-wiry-rapid pulse (Exterior is Muscle Heat, Interior is Steaming Heat, Blocking is Accumulated Heat); also treats Malaria (Yu Jiayan said: Hezi's method slightly applies attack and tonification, deeply hitting the mark). Adding Qiang Huo, Fang Feng to this formula is named Chai Hu Qiang Huo Tang, treats Warm Epidemic Shaoyang pattern. Adding Jie Geng to this formula is named Chai Hu Jie Geng Tang: Treats Spring Cough. Combining with Ping Wei San is named Chai Ping Tang: Treats Damp Malaria with body pain and heaviness. Adding Qing Dai, paste pills with Ginger Juice is named Qing Zhen Wan (Jie Gu): Treats vomiting, wiry pulse headache, and hot cough. One part of this formula plus two parts Si Wu Tang is named Chai Hu Si Wu Tang: Treats women's long-term deficiency consumption with slight chills/fever. Half this formula, half Si Wu Tang is named Tiao Jing Tang.